Digitalis has been used for over 200 years to treat patients with heart failure (HF). Evidence from clinical trials supports the use of digoxin (the most widely used formulation of digitalis) in patients with HF due to left ventricular systolic dysfunction, particularly in patients with more advanced symptoms [1]. However, there is no evidence that digoxin improves survival.

Digitalis also exerts an antiadrenergic action in patients with heart failure (HF) by inhibiting sympathetic outflow and augmenting parasympathetic tone. These actions may contribute to the clinical utility of digitalis in some patients.

Digitalis can also be beneficial in patients with HF due to systolic dysfunction with atrial fibrillation (AF) with rapid ventricular response [1], though other agents are preferred for rate control. For patients with compensated systolic HF and AF, a beta blocker (with or without adjunctive digoxin) is generally preferred for rate control. Digitalis slows the ventricular rate during AF, largely via increased parasympathetic tone. Through both rate control and improved contractility, digitalis relieves symptoms of systolic HF when associated with AF and a rapid ventricular rate. (See "Control of ventricular rate in atrial fibrillation: Pharmacologic therapy" and "The management of atrial fibrillation in patients with heart failure".)

To continue reading this article, you must log in with your personal, hospital,
or group practice subscription. For more information or to purchase a personal subscription, click below on
the option that best describes you: